天津市医疗机构丙肝病例诊断及报告质量现况调查

目的 了解天津市医疗机构丙肝病例诊断与报告现状, 为提高丙肝疫情监测能力和医疗机构传染病报告管理水平提供科学依据。方法 以天津市二级及以上所有具有抗-HCV检测能力的79家医疗机构为研究对象，每家机构按30%的比例随机抽取抗-HCV检测阳性的住院病例共1 232例，通过查阅医疗机构门诊日志、病案室登记及实验室检测等方式对丙肝报告情况进行调查。结果 天津市被调查医疗机构仅27.85%的医院具有HCV RNA检测能力，抗-HCV阳性报告率为36.28%，HCV-RNA阳性报告率为62.13%，三级医院指标阳性报告率明显高于二级医院；丙肝误诊率为4.30%，临床诊断病例漏诊率为70.90%，三级医院误诊率及漏诊率均明显低于二级医院；报告病例诊断分类正确率为66.67%，急慢性分类正确率为99.50%，三级医院的报告病例诊断分类率和急慢性分类正确率均高于二级医院。结论 目前天津市医疗机构丙肝病例诊断和报告质量较低，医疗机构需提高丙肝病例报告质量，为政府丙肝防治卫生政策的制定提供科学依据。

A cross-sectional study on the quality of medical diagnosis and reporting of hepatitis C in Tianjin

Objective The aim of this study was to understand the problems existed in hepatitis C case diagnosis and reporting in medical institutions in Tianjin, in order to provide basis for further improvement on standard of report procedure and quality of hepatitis C case report. Methods A total of 79 medical institutions with second and above anti-HCV detection capability were evaluated. A total of 1232 cases tested positive for anti-HCV were selected by 30% from each hospital. To understand hepatitis c epidemic situation, report on medical institutions outpatient logs, medical records room registration, laboratory testing and telephone interviews were investigated. Results The results showed that only 27.85 percent of hospitals had HCV RNA testing qualification in Tianjin medical institutions surveyed. Anti-HCV positive report was 36.28%. HCV-RNA positive report was 62.13% (tertiary hospitals was significantly higher than two hospitals). HCV misdiagnosis rate was 4.30%. Clinically diagnosed cases missed was 70.90%. The rate of misdiagnosis and missed three hospitals were significantly lower than the two hospitals. Reported cases of diagnostic classification accuracy was 66.67%. Acute and chronic classification accuracy was 99.50%. The rate of reported cases of diagnostic classification tertiary hospitals and acute and chronic classification accuracy rate was higher than the two hospitals. Conclusion At present, Tianjin medical diagnosis and reporting of cases of hepatitis C was in low quality. It is suggested to strengthen the training of hepatitis C corresponding content, improve the quality of reporting of cases of hepatitis C, to provide a scientific basis for government decision-making.